201
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Queiroz TN, Bisinotto FMB, Silva TMDM, Martins LB. [Anesthesia for cesarean section in pregnant woman with Guillain Barré syndrome: a case report]. Rev Bras Anestesiol 2014; 64:369-72. [PMID: 25168443 DOI: 10.1016/j.bjan.2013.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 02/28/2013] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Guillain Barré syndrome (GBS) is an autoimmune neurological disease characterized by an acute or subacute demyelinating polyradiculoneuritis. It is an unusual event during pregnancy and a challenge for the anesthesiologist, due to the possibility of impairment of neuromuscular function and occurrence of respiratory complications in the postoperative period. The objective of this paper is to discuss the anesthetic management of a pregnant patient affected by the disease. CASE REPORT Female patient, 30 years old, 38 weeks' pregnant, diagnosed with fetal death that occurred about a day, and with SGB. Cesarean section was performed under general anesthesia, progressing without complications perioperatively. CONCLUSIONS Although it is uncommon, GBS can affect pregnant women and the anesthesiologist may encounter such patients in his (her) daily practice. It is important to understand the peculiarities of GBS to adequately address the patient in the perioperative period, contributing to its better evolution.
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Affiliation(s)
- Thiago Nobre Queiroz
- Programa de Residência Médica em Anestesiologia, Hospital das Clínicas, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brasil.
| | | | - Thaisa Mara da Mota Silva
- Programa de Residência Médica em Oftalmologia, Hospital das Clínicas da Universidade Federal de Uberlândia, Uberlândia, MG, Brasil
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202
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Chammas M, Boretto J, Burmann LM, Ramos RM, Dos Santos Neto FC, Silva JB. Carpal tunnel syndrome - Part I (anatomy, physiology, etiology and diagnosis). Rev Bras Ortop 2014; 49:429-36. [PMID: 26229841 PMCID: PMC4487499 DOI: 10.1016/j.rboe.2014.08.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 08/28/2013] [Indexed: 12/31/2022] Open
Abstract
Carpal tunnel syndrome (CTS) is defined by compression of the median nerve in the wrist. It is the commonest of the compressive syndromes and its most frequent cause is idiopathic. Even though spontaneous regression is possible, the general rule is that the symptoms will worsen. The diagnosis is primarily clinical, from the symptoms and provocative tests. Electroneuromyographic examination may be recommended before the operation or in cases of occupational illnesses.
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Affiliation(s)
- Michel Chammas
- Hand and Upper-Limb Surgery Service, Peripheral Nerve Surgery, Hospital Lapeyronie, University Hospital Center, Montpellier, France
| | - Jorge Boretto
- Hand Surgery Service, Italian Hospital, Buenos Aires, Argentina
| | - Lauren Marquardt Burmann
- Hand Surgery Service, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS, Brazil
| | - Renato Matta Ramos
- Hand Surgery Service, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS, Brazil
| | - Francisco Carlos Dos Santos Neto
- Hand Surgery Service, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS, Brazil
| | - Jefferson Braga Silva
- Hand Surgery Service, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS, Brazil
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203
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Ang CL, Foo LSS. Multiple locations of nerve compression: an unusual cause of persistent lower limb paresthesia. J Foot Ankle Surg 2014; 53:763-7. [PMID: 25128915 DOI: 10.1053/j.jfas.2014.06.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Indexed: 02/03/2023]
Abstract
A paucity of appreciation exists that the "double crush" phenomenon can account for persistent leg symptoms even after spinal neural decompression surgery. We present an unusual case of multiple locations of nerve compression causing persistent lower limb paresthesia in a 40-year old male patient. The patient's lower limb paresthesia was persistent after an initial spinal surgery to treat spinal lateral recess stenosis thought to be responsible for the symptoms. It was later discovered that he had peroneal muscle herniations that had caused superficial peroneal nerve entrapments at 2 separate locations. The patient obtained much symptomatic relief after decompression of the peripheral nerve. The "double crush" phenomenon and multiple levels of nerve compression should be considered when evaluating lower limb neurogenic symptoms, especially after spinal nerve root surgery.
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Affiliation(s)
- Chia-Liang Ang
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
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204
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Value of Surgical Decompression of Compressed Nerves in the Lower Extremity in Patients with Painful Diabetic Neuropathy. Plast Reconstr Surg 2014; 134:325-332. [DOI: 10.1097/prs.0000000000000369] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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205
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Abstract
The effect of screen based keyboard (SBK) operation on extensibility of the neural system was investigated using the radial nerve upper limb tension test (Butler 1991). Twenty-five female subjects (aged 17-55 years) including 15 SBK operators and 10 non-SBK operators who acted as a control were examined. Mean glenohumeral abduction in the upper limb tension test in the control group was 40 degrees. In the SBK operators, it was 27 degrees (right side) and 30 degrees (left side). Statistical analysis showed a significant difference between the groups. Results indicate that the normal mechanics of the neural system may be affected by SBK operation and that neural tension warrants consideration in the prevention and management of work related neck and upper limb disorders.
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206
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Watson PCN, Mackinnon SE, Dostrovsky JO, Bennett GJ, Farran PR, Carlson T. Nerve resection, crush and re-location relieve complex regional pain syndrome type II: A case report. Pain 2014; 155:1168-1173. [DOI: 10.1016/j.pain.2014.01.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 01/13/2014] [Accepted: 01/28/2014] [Indexed: 10/25/2022]
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207
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Chammas M. Carpal tunnel syndrome. ACTA ACUST UNITED AC 2014; 33:75-94. [DOI: 10.1016/j.main.2013.11.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 10/31/2013] [Accepted: 11/11/2013] [Indexed: 02/07/2023]
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208
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Sessions J, Nickerson DS. Biologic Basis of Nerve Decompression Surgery for Focal Entrapments in Diabetic Peripheral Neuropathy. J Diabetes Sci Technol 2014; 8:412-418. [PMID: 24876595 PMCID: PMC4455405 DOI: 10.1177/1932296814525030] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The most recent (2011) National Diabetes Fact Sheet states the combined diagnosed and undiagnosed number of diabetes cases in the United States is approaching 25 million, and another 79 million are prediabetic. Of the diabetes patients, 60-70% suffer from mild to severe neuropathy. This combined loss of sensory and motor control in diabetic limbs is usually considered an irreversible, progressive process. Patients suffering from these losses are at a significantly higher risk for development of foot ulceration, frequently leading to infection and partial or major limb amputation. However, a review of focal nerve entrapment surgical decompression literature suggests that several diabetic sensorimotor polyneuropathy (DSPN) symptoms and complications are potentially partially reversible or preventable. Decompression surgery represents a paradigm shift in treatment protocols because it both relieves pain and restores protective sensation, while providing significant protection against a cascade of serious foot complications. This review surveys current research regarding the biological basis for diabetic focal entrapment neuropathy. Metabolic dysfunction related to aldose reductase, oxidative stress, and advanced glycation end products are considered and correlated to peripheral nerve enlargement and entrapment. In addition, observational studies correlated to that biological basis are presented as well as surgical outcomes illustrating the effect of decompression on DSPN symptomatic relief, nerve function, and protection against complications.
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Affiliation(s)
| | - D Scott Nickerson
- Northeast Wyoming Wound Clinic, Sheridan Memorial Hospital, Sheridan, WY, USA
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209
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Torres ALG, Ferreira MC. Study of the anatomy of the tibial nerve and its branches in the distal medial leg. ACTA ORTOPEDICA BRASILEIRA 2014; 20:157-64. [PMID: 24453596 PMCID: PMC3718430 DOI: 10.1590/s1413-78522012000300005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Accepted: 07/19/2011] [Indexed: 12/31/2022]
Abstract
Objective Determine, through dissection in fresh cadavers, the topographic anatomy of the tibial
nerve and its branches at the ankle, in relation to the tarsal tunnel. Methods Bilateral dissections were performed on 26 fresh cadavers and the locations of the
tibial nerve bifurcation and its branches were measured in millimeters. For the
calcaneal branches, the amount and their respective nerves of origin were also
analyzed. Results The tibial nerve bifurcation occurred under the tunnel in 88% of the cases and
proximally in 12%. As for the calcaneal branches, the medial presented with one (58%),
two (34%) and three (8%) branches, with the most common source occurring in the tibial
nerve (90%) and the lower with a single branch per leg and lateral plantar nerve as the
most common origin (70%). Level of Evidence, V Expert
opinion.
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210
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Surgical treatment of superimposed, lower extremity, peripheral nerve entrapments with diabetic and idiopathic neuropathy. Ann Plast Surg 2014; 70:675-9. [PMID: 23673565 DOI: 10.1097/sap.0b013e3182764fb0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although it is recognized that people with peripheral neuropathy have an increased prevalence of chronic nerve entrapment, controversy still exists over their management. The present report details the evaluation, surgical approach, and outcome of a large cohort of people with diabetic and with idiopathic neuropathy. METHODS A retrospective review of 158 consecutive patients, 96 with diabetic and 62 with idiopathic neuropathy, was done to analyze the results of neurolysis of multiple sites of chronic nerve compression in the lower extremity. Of these patients, 50 had a contralateral limb decompressed for a total of 208 limbs included in the study. Outcomes included visual analog scale (VAS) for pain in the 109 patients who had pain level greater than 8.0, measurement of the cutaneous pressure threshold for sensibility, self-reported change in pain medication usage, and self-reported change in balance. RESULTS With a minimum follow-up of 1 year, 88% of patients with preoperative numbness reported improvement in sensation (P < 0.001). Of the 84 patients with impaired balance, 81% reported improvement in balance. Of those whose VAS was greater than 8, 83% reported an improvement in VAS (P < 0.001). There was a concomitant reduction in pain medication usage. There was no difference in outcomes between patients with diabetic versus idiopathic neuropathy in response to nerve decompression. CONCLUSIONS Neurolysis of lower extremity chronic nerve compressions in patients with neuropathy and superimposed nerve compressions is an effective method for relieving pain, restoring sensation, and improving balance.
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211
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Abstract
Median nerve injury is rarely associated with the humeral shaft fracture. A Sixty two year old woman with a displaced humeral shaft fracture, developed a symptomatic carpal tunnel syndrome after plating with a screw protruding medially. 16 months later, the implants were removed and the symptoms gradually improved without carpal tunnel release surgery. A double crush syndrome resulted due to the proximal compression by the medially protruding screw and the distal compression by carpal tunnel. The proximal decompression produced by removal of the screw led to relief of the symptoms.
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Affiliation(s)
- Yi-Gang Huang
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China,Address for correspondence: Dr. Yi-Gang Huang, 600 Yi Shan Road, Shanghai, China. E-mail:
| | - Shi-Min Chang
- Department of Orthopedics,Yangpu Hospital, Tongji University, Shanghai, China
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212
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Macaré van Maurik JFM, Schouten MEL, ten Katen I, van Hal M, Peters EJG, Kon M. Ultrasound findings after surgical decompression of the tarsal tunnel in patients with painful diabetic polyneuropathy: a prospective randomized study. Diabetes Care 2014; 37:767-72. [PMID: 24379356 DOI: 10.2337/dc13-1787] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE It has been hypothesized that the development of diabetic polyneuropathy (DPN) is due to swelling of the nerve, as well as thickening and stiffening of the surrounding ligaments, causing chronic compression of nerves. We aimed to examine the effect of surgical decompression of the tibial nerve on the mean cross-sectional area (CSA). RESEARCH DESIGN AND METHODS We performed a randomized controlled trial of 42 subjects with painful DPN diagnosed using the Diabetic Neuropathy Score. A computer randomized for the surgery arm of the study. A control group consisting of 38 healthy subjects was included. An experienced sonographer measured the CSA and thickness-to-width (T/W) ratio of the tibial nerve, as well as the thickness of the flexor retinaculum. RESULTS CSA is significantly larger in patients with painful DPN (8.4 ± 3.9 mm(2)) than in control subjects (6.4 ± 1.3 mm(2)), P = 0.007. The T/W ratio in patients with painful DPN is 0.64 and in control subjects 0.59, P = 0.03. Patients with DPN have a significantly thicker retinaculum (1.07 mm) than control subjects (0.84 mm), P < 0.001. Mean follow-up was 28.2 weeks (range 23-45). Difference between baseline and follow-up in the operated leg was 1.49 mm(2) and in the control leg 1.81 mm(2), P = 0.674. CONCLUSIONS Decompression of the tibial nerve does not result in a significant difference between baseline and follow-up in CSA using ultrasound between the operated and control leg. Ultrasound measurements show a significantly increased CSA, a significantly thicker retinaculum, and a significantly increased T/W ratio in patients with painful DPN compared with healthy control subjects. Clinical trial reg. no. NTR2344, www.trialregister.nl.
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213
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Illes JD, Johnson TL. Chiropractic management of a patient with ulnar nerve compression symptoms: a case report. J Chiropr Med 2013; 12:66-73. [PMID: 24294148 DOI: 10.1016/j.jcm.2013.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 02/04/2013] [Accepted: 03/07/2013] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The purpose of this case report is to describe chiropractic management of a patient with arm and hand numbness and who was suspected to have ulnar nerve compression. CLINICAL FEATURES A 41-year-old woman presented with hand weakness and numbness along the medial aspect of her right forearm and the 3 most medial fingers. The onset of symptoms presented suddenly, 3 weeks prior, when she woke up in the morning and assumed she had "slept wrong." The patient's posture showed protracted shoulders and moderate forward head carriage. Orthopedic assessment revealed symptomatic right elevated arm stress test, grip strength asymmetry, and a Tinel sign at the right cubital tunnel. INTERVENTION AND OUTCOME The patient was treated using chiropractic care, which consisted of manipulative therapy, myofascial therapy, and elastic therapeutic taping. Active home care included performing postural exercises and education about workstation ergonomics. She demonstrated immediate subjective improvement of her numbness and weakness after the first treatment. Over a series of 11 treatments, her symptoms resolved completely; and she was able to perform work tasks without dysfunction. CONCLUSION Chiropractic treatment consisting of manipulation, soft tissue mobilizations, exercise, and education of workstation ergonomics appeared to reduce the symptoms of ulnar nerve compression symptoms for this patient.
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Affiliation(s)
- Jennifer D Illes
- Clinical Science Instructor, National University of Health Sciences, Pinellas Park, FL
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214
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Wiesman IM, Novak CB, Mackinnon SE, Winograd JM. Sensitivity and specificity of clinical testing for carpal tunnel syndrome. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2013; 11:70-2. [PMID: 24222987 DOI: 10.1177/229255030301100205] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The present study evaluated the sensitivity, specificity and predictive values of six clinical tests in the diagnosis of carpal tunnel syndrome (CTS). METHODS There were 29 carpal tunnel syndrome (CTS) subjects (mean age 48 years) and 30 control subjects (mean age 45 years). The six clinical tests included Tinel's sign, wrist flexion with fingers extended, wrist flexion with fingers flexed, wrist extension, combined wrist extension/median nerve pressure and combined wrist flexion/median nerve pressure. RESULTS The highest sensitivity and highest negative predictive value was found with wrist flexion with pressure (96%) and wrist extension with pressure (94%) at 60 s. The highest specificity was found with wrist flexion with fingers flexed for 30 s (95%). The highest positive predictive values were found with the wrist flexion with fingers flexed test for 30 s (91%) and the wrist extension test for 30 s (90%). CONCLUSION No one test possesses all the qualities necessary to be the ideal clinical test for the detection of carpal tunnel syndrome.
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Affiliation(s)
- Irvin M Wiesman
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St Louis, Missouri, USA
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215
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Wu JD, Huang WH, Huang ZY, Chen M, Zhang GJ. Brachial plexus palsy after a left-side modified radical mastectomy with immediate latissimusdorsi flap reconstruction: report of a case. World J Surg Oncol 2013; 11:276. [PMID: 24127915 PMCID: PMC3853354 DOI: 10.1186/1477-7819-11-276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 10/01/2013] [Indexed: 02/05/2023] Open
Abstract
Brachial plexus injury is a rare complication during operation and anesthesia; it can occur as a result of various mechanisms such as inappropriate positioning, over-abduction and stretching the upper limbs. Brachial plexus injury can cause the poor function of the upper limb before recovery, and sometimes serious injury is unable to completely recovered the function permanently. Here, we report a female breast cancer patient who sustained a left brachial plexus palsy after modified radical mastectomy with immediate breast reconstruction with latissimusdorsi flap (LDF). The patient had fully recovered with normal function of her left upper limb six months postoperation after conservative treatment.
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Affiliation(s)
- Jun-Dong Wu
- The Breast Center, Cancer Hospital of Shantou University Medical College, 7 Raoping Rd, Shantou, Guangdong 515041, China
| | - Wen-He Huang
- The Breast Center, Cancer Hospital of Shantou University Medical College, 7 Raoping Rd, Shantou, Guangdong 515041, China
| | - Zi-Yi Huang
- The Breast Center, Cancer Hospital of Shantou University Medical College, 7 Raoping Rd, Shantou, Guangdong 515041, China
| | - Ming Chen
- The Breast Center, Cancer Hospital of Shantou University Medical College, 7 Raoping Rd, Shantou, Guangdong 515041, China
| | - Guo-Jun Zhang
- The Breast Center, Cancer Hospital of Shantou University Medical College, 7 Raoping Rd, Shantou, Guangdong 515041, China
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216
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Common peroneal nerve palsy following total knee arthroplasty: prognostic factors and course of recovery. J Arthroplasty 2013; 28:1538-42. [PMID: 23562462 DOI: 10.1016/j.arth.2013.02.025] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 10/16/2012] [Accepted: 02/19/2013] [Indexed: 02/01/2023] Open
Abstract
Common peroneal nerve palsy (CPNP) is a serious complication following total knee arthroplasty (TKA). There is little information regarding the clinical course and prognostic factors for recovery. Between January 2000 and December 2008, 44 patients (0.53%) developed CPNP following TKA and were matched to 100 control patients based on year of surgery, type of surgery and surgeon. Regression analysis was performed to identify prognostic factors for recovery. A significant difference was seen in CPNP patients who were on average younger (62.1 years) and had higher BMI (34.5 kg/m(2)) than those who did not have nerve palsy (67.5 years and 31.8 kg/m(2), respectively). Only 37 patients with palsies could be followed, 32 (62.2%) had incomplete nerve palsy, twenty four (75%) of them fully recovered, while only 1 of patients with complete nerve palsy fully recovered. More severe initial injury was a negative prognostic factor for recovery of palsy (P<0.03).
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217
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The Positive Effect of Neurolysis on Diabetic Patients with Compressed Nerves of the Lower Extremities: A Systematic Review and Meta-analysis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2013; 1:e24. [PMID: 25289218 PMCID: PMC4173835 DOI: 10.1097/gox.0b013e318299d02b] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 05/01/2013] [Indexed: 12/27/2022]
Abstract
Background: Despite proven benefits of upper extremity nerve decompression in diabetics, neurolysis for diabetic patients with lower extremity (LE) nerve compression remains controversial. Methods: A search of ClinicalTrials.gov and Cochrane clinical trials registries, CENTRAL (The Cochrane Library), MEDLINE, EMBASE, LILACS, CINAHL, SCOPUS, and Google Scholar from 1962 to 2012, yielded 1956 citations. Any potential randomized or quasi-randomized controlled trials and observational cohort studies of diabetics with neurolysis of the common peroneal nerve, deep peroneal nerve, or tibial nerve were assessed. We included articles in any language that 1) provided information about diabetic patients who had neurolysis for symptomatic nerve compression diagnosed by (+) Tinel sign or electrodiagnostic study, and 2) quantified outcomes for pain, sensibility, or ulcerations/amputations. Case reports, review articles, animal or cadaver studies, and studies with <10 patients were excluded. We assessed pain relief, recovery of sensibility, and postoperative incidence of ulcerations/amputations at follow-up >3 months. A meta-analysis of descriptive statistics was performed. Results: Ten clinical series with a mean clinical relevance score of 70% and a mean methodologic quality score of 50% met inclusion criteria. We included 875 diabetic patients and 1053 LEs. Pain relief >3 points on visual analog scale occurred in 91% of patients; sensibility improved in 69%. Postoperative ulceration/amputation incidence was significantly reduced compared to preoperative incidence (odds ratio = 0.066, 95% confidence interval = 0.026–0.164, P < 0.0001). Conclusions: Observational data suggest that neurolysis significantly improves outcomes for diabetic patients with compressed nerves of the LE. No randomized controlled trials have been published.
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218
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Abstract
Peripheral nerve injuries are common conditions, with broad-ranging groups of symptoms depending on the severity and nerves involved. Although much knowledge exists on the mechanisms of injury and regeneration, reliable treatments that ensure full functional recovery are scarce. This review aims to summarize various ways these injuries are classified in light of decades of research on peripheral nerve injury and regeneration.
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Affiliation(s)
- Ron M G Menorca
- School of Medicine and Dentistry, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY 14642, USA
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219
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220
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Nye ZB, Horn JL, Crittenden W, Abrahams MS, Aziz MF. Ambulatory continuous posterior lumbar plexus blocks following hip arthroscopy: a review of 213 cases. J Clin Anesth 2013; 25:268-74. [DOI: 10.1016/j.jclinane.2012.11.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 10/12/2012] [Accepted: 11/11/2012] [Indexed: 10/26/2022]
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221
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Murthy PG, Abzug JM, Jacoby SM, Culp RW. The tenosynovial flap for recalcitrant carpal tunnel syndrome. Tech Hand Up Extrem Surg 2013; 17:84-86. [PMID: 23689854 DOI: 10.1097/bth.0b013e318281d0e8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Operative intervention for recalcitrant carpal tunnel syndrome often utilizes local vascularized tissue to provide coverage of the median nerve in an attempt to limit scarring or adherence of the nerve to its surrounding structures. Although the hypothenar fat pad is the most commonly cited source of vascularized tissue, alternative options do exist. We review the technique of utilizing a pedicled tenosynovial flap as the source of local vascularized tissue for coverage of the median nerve in cases of recalcitrant carpal tunnel syndrome.
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Affiliation(s)
- Praveen G Murthy
- Department of Orthopedic Surgery, Division of Hand Surgery, Thomas Jefferson University, Philadelphia, PA, USA
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222
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Yan H, Gao W, Pan Z, Zhang F, Fan C. The expression of α-SMA in the painful traumatic neuroma: potential role in the pathobiology of neuropathic pain. J Neurotrauma 2013; 29:2791-7. [PMID: 23020218 DOI: 10.1089/neu.2012.2502] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The exact mechanism of neuroma-associated pain is not yet fully understood, thus contributing to the substantial challenge faced in managing patients with painful neuromas. We aimed to observe the expression of alpha smooth muscle actin (α-SMA) in the painful traumatic neuroma and to investigate its possible roles in the cause of neuroma-associated pain. Its expression is considered to be a useful phenotypic marker for myofibroblast, and may contribute to its increased contractile activity. We collected peripheral neuroma specimens prospectively and subsequently divided them into two groups: painful (n=21) and non-painful (n=27) based on blinded preoperative visual analogue scale (VAS) pain scores. We also harvested normal nerve specimens from the discarded limbs as a control group (n=8). We performed immunohistological studies to observe the expression of α-SMA in each group, and calculated the expression level by a high-resolution pathological image analysis system. There was no positive staining of α-SMA observed in the control group, slight positive staining in the non-painful group, and obviously positive staining in the painful group. Pearson correlation analysis demonstrated that VAS scores were significantly associated with the expression intensity of α-SMA (R=0.831; p<0.001). Linear regression analysis indicated that the expression intensity of α-SMA was positively related to the scale of VAS (R(2)=0.691, p<0.001). These findings suggest that: 1) expression of α-SMA may play certain roles in painful traumatic neuroma, either as a direct cause of neuroma-associated pain or as an indirect marker of local mechanical stimuli, and 2) the presence of α-SMA in the painful group may provide rationale for transpositional procedures in the management of traumatic neuroma. The persistent existence of α-SMA in the painful group and the correlation with VAS scores may provide insight into the development of new therapeutic strategies.
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Affiliation(s)
- Hede Yan
- Department of Orthopedics, The Sixth Affiliated People's Hospital, Shanghai Jiao Tong University, China
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223
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Borgia AV, Hruska JK, Braun K. Double crush syndrome in the lower extremity: a case report. J Am Podiatr Med Assoc 2013; 102:330-3. [PMID: 22826333 DOI: 10.7547/1020330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Upton and McComas first described double crush syndrome in 1973. The theory behind double crush syndrome postulated that a proximal lesion in a nerve would make that same nerve more vulnerable to additional distal lesions. Many of the studies investigating the possibility of the double crush syndrome involve lesions in the upper extremity with very few articles written specifically about double crush syndrome in the lower extremity. We present the case of a 33-year-old massage therapist who uses her feet to provide therapy to clients who presented to our clinic with symptoms consistent with tarsal tunnel syndrome. Her failure to progress in a satisfactory manner after a variety of therapies made us search for additional etiologies for her foot pain. In cases where tarsal tunnel persists after surgical therapy, the treating physician should search for more proximal lesions along the course of the nerve.
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Affiliation(s)
- Anthony V Borgia
- Department of Surgery, University Medical Center, Las Vegas, Nevada, USA.
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MRI findings in patients with tibial nerve compression near the knee. Skeletal Radiol 2013; 42:553-9. [PMID: 23322024 DOI: 10.1007/s00256-012-1571-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 12/19/2012] [Accepted: 12/22/2012] [Indexed: 02/02/2023]
Abstract
The soleus sling has been recently identified as a site of compression of the tibial nerve resulting in tibial neuropathy. Diagnosis of soleal sling syndrome is difficult, and has been based mainly on clinical examination. Advances in MR imaging with high-resolution 3-Tesla scanners have made direct visualization of nerve pathology possible. With the use of high-resolution imaging and fat-suppression protocols, tibial nerve compression at the soleal fascial arch can be demonstrated in a subset of patients presenting with idiopathic tibial neuropathy. The purpose of this paper is to confirm the ability of MR imaging to demonstrate pathologic changes in the tibial nerve in patients presenting with soleal sling syndrome. Additionally, patients presenting with tibial neuropathy and ganglion cysts, both extra- and intraneural, were examined to determine if the site of compression corresponded to the region of the soleus sling. Nine patients were included in the study, two with idiopathic soleus sling syndrome, four with extraneural, and three with intraneural ganglion cysts. In the patients presenting with idiopathic soleus sling syndrome, MR imaging demonstrated a thickened soleus sling with T2 hyperintensity of the tibial nerve at the level of the sling and denervation changes in muscles of the posterior compartment of the leg. In patients with extraneural ganglion cysts, MR imaging demonstrated a "sandwich"-like compression of the tibial nerve between the cyst and the soleus sling with corresponding tibial nerve T2 hyperintensity and denervation change in posterior compartment muscles. No compression of the tibial nerve at the soleus sling was found in the intraneural ganglion population. We conclude that MR imaging is effective in demonstrating pathologic changes in the tibial nerve at the soleus sling. Based on the MRI findings, we also believe that the soleus sling is a component of the compression when patients present with extraneural ganglion cysts and tibial neuropathy near the knee; in these patients, we recommend release of the soleus sling as part of the definitive management.
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225
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Molinari WJ, Elfar JC. The double crush syndrome. J Hand Surg Am 2013; 38:799-801; quiz 801. [PMID: 23466128 PMCID: PMC5823245 DOI: 10.1016/j.jhsa.2012.12.038] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 12/18/2012] [Accepted: 12/30/2012] [Indexed: 02/02/2023]
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226
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Dufour E, Toussaint A, Liu N, Fischler M, Nourry G, Vercoutère M. Ultrasound-guided perineural circumferential median nerve block in carpal tunnel syndrome. Anaesthesia 2013; 68:434-6. [PMID: 23488853 DOI: 10.1111/anae.12212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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227
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Abstract
Brachial plexus compression (BPC) occurs above the clavicle as neurogenic thoracic outlet syndrome (NTOS) and below as neurogenic pectoralis minor syndrome (NPMS). It was recently noted that 75% of the adults seen for NTOS also had NPMS and in some this was the only diagnosis. This is also true in children but has not yet been reported. Because surgical treatment of NPMS is a minimum risk operation for pectoralis minor tenotomy (PMT), recognition of NPMS and distinguishing it from NTOS becomes important. In this study, 40 operations, 20 PMT and 20 NTOS procedures, were performed. Success rate for PMT was 85% and for thoracic outlet decompression was 70%. It was concluded that in children, as in adults, BPC is more often due to combined NTOS and NPMS. Surgical PMT should be considered first as the treatment of choice for children with NPMS. Thoracic outlet decompression is available if PMT is unsuccessful.
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228
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Kim JH, Gong HS, Lee HJ, Lee YH, Rhee SH, Baek GH. Pre- and post-operative comorbidities in idiopathic carpal tunnel syndrome: cervical arthritis, basal joint arthritis of the thumb, and trigger digit. J Hand Surg Eur Vol 2013; 38:50-6. [PMID: 22553311 DOI: 10.1177/1753193412445441] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We retrospectively reviewed 633 hands in 362 patients who had idiopathic carpal tunnel syndrome and underwent carpal tunnel release between 1999 and 2009. Electrophysiological studies and simple radiographs of the wrist, cervical spine, and basal joint of the thumb were routinely checked, and patients were also assessed for the presence of trigger digit or de Quervain's disease before and after surgery. Among 362 patients, cervical arthritis was found in 253 patients (70%), and C5-C6 arthritis was the most common site. Basal joint arthritis of the thumb was observed in 216 (34%) of the 633 hands. Trigger digit or de Quervain's disease was observed in 85 of the 633 hands (13%) before surgery, and developed in 67 hands (11%) after surgery. Cervical arthritis, basal joint arthritis, and trigger digit commonly coexist with idiopathic carpal tunnel syndrome. Patient education about these disorders is very important when they coexist with idiopathic carpal tunnel syndrome.
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Affiliation(s)
- J H Kim
- Department of Orthopaedic Surgery, Seoul National University Boramae Medical Center, Seoul, South Korea
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229
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Cervical Spine Disease Is a Risk Factor for Persistent Phrenic Nerve Paresis Following Interscalene Nerve Block. Reg Anesth Pain Med 2013; 38:239-42. [DOI: 10.1097/aap.0b013e318289e922] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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230
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Chen Y, Kumar N, Lim JWW, Smith EW. High-resolution sonography detects extraforaminal nerve pathology in patients initially diagnosed with cervical disc disease: a case series. JOURNAL OF CLINICAL ULTRASOUND : JCU 2013; 41:46-54. [PMID: 22006670 DOI: 10.1002/jcu.20876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 08/16/2011] [Indexed: 05/31/2023]
Abstract
In patients presenting with neck and upper limb complaints, MRI changes suggestive of cervical disc disease do not exclude concomitant extraforaminal pathology, as shown in the series of three cases presented here. High-resolution ultrasound of the brachial plexus and peripheral nerves may be useful in identifying an extraforaminal pathology when (1) symptoms and signs are disproportionate to MRI findings of cervical disc disease; (2) there is obvious discordance between MRI and nerve conduction findings; (3) an entrapment neuropathy is suspected but the site of nerve lesion is unidentifiable on the basis of available investigations and clinical findings.
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231
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Chidambaran V, Mahmoud M, Sadhasivam S. Risk for peroneal nerve injury after femur osteosarcoma resection: is regional analgesia safe? J Clin Anesth 2012; 25:76-8. [PMID: 23246492 DOI: 10.1016/j.jclinane.2012.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 05/15/2012] [Accepted: 06/04/2012] [Indexed: 11/15/2022]
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Abstract
BACKGROUND One of the main causes of diabetic neuropathy is endoneurial edema, which increases the internal pressure of the perineurium, which has a tight structure. The treatment used to reduce internal pressure is perineurotomy, in which a surgical incision is made into the perineurium. METHODS Forty male Sprague-Dawley rats were used in the study. They were classified into four groups. Streptozotocin-induced diabetes was created in groups III and IV. The sciatic nerve was transected and repaired epineurally in all groups. Perineurotomy was performed additionally in group II and IV to the sciatic, peroneal, tibial, and sural nerves from the most proximal side to their most distal ends. The sciatic function indices were calculated for functional assessment. Light and electron microscopic evaluations were performed for morphometric assessment. In addition, the myelinated and degenerated fibers were counted in all groups. RESULTS The sciatic function indices of the diabetic perineurotomy group were found to be significantly higher than those of the other groups (p < 0.05). Based on the myelinated fiber counts, there was insignificant difference between group I and group II, whereas the difference was significant (p < 0.05) between group III and group IV. Presence of peripheric nerves in light microscopic evaluation revealed normal characteristics of myelinated fibers in group I and group II. The myelinated axon profile in group IV was similar to that of groups I and II in electron microscopic evaluation. CONCLUSION It is concluded that perineurotomy may be established as a useful adjunctive procedure for nerve repair in diabetic patients.
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234
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Huang YG, Cheng LM. How to diagnose double crush syndrome? Rheumatol Int 2012; 32:3325-6. [DOI: 10.1007/s00296-011-2128-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 08/22/2011] [Indexed: 10/17/2022]
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235
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Nellans K, Tang P. Evaluation and treatment of failed ulnar nerve release at the elbow. Orthop Clin North Am 2012; 43:487-94. [PMID: 23026464 DOI: 10.1016/j.ocl.2012.07.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Failure after ulnar nerve decompression at the elbow can be defined as either no change in the patient's symptoms or an initial improvement with recurrence, making the patient history essential in the work-up. Failure may be due to diagnostic, technical, or biologic factors. Technical errors and the development of perineural fibrosis necessitate revision surgery, while nerve damage due to chronic severe compression should be observed. We do not believe any one procedure is superior in the revision setting as long as a complete decompression is achieved with a compression free, stable transposition of the surgeon's choice.
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Affiliation(s)
- Kate Nellans
- Department of Orthopaedic Surgery, New York Presbyterian Hospital, Columbia University, New York, NY 10032, USA
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236
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Walsh MT. Interventions in the disturbances in the motor and sensory environment. J Hand Ther 2012; 25:202-18; quiz 219. [PMID: 22507214 DOI: 10.1016/j.jht.2011.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 12/14/2011] [Accepted: 12/15/2011] [Indexed: 02/03/2023]
Abstract
Treatment of peripheral nervous system (PNS) pathology presents intervention challenges to every therapist. Many of the current and future interventions will be directed at restoring the normal anatomy, function, and biomechanical properties of the PNS, restoring normal neural physiology and ultimately patient function and quality of life. Present interventions use mechanical (movement) or electrical procedures to affect various properties of the peripheral nerve. The purpose of this article was to apply basic science to clinical practice. The pathology and accompanying structural and biomechanical changes in the PNS will be presented in three specific areas commonly encountered in the clinic: nerve injury and laceration; compression neuropathies; and neuropathic pain and neural tension dysfunction. The intent is to address possible interventions exploring the clinical reasoning process that combines basic science and evidence-based best practice. The current lack of literature to support any one intervention requires a strong foundation and understanding of the PNSs' structure and function to refine current and develop new intervention strategies. Current evidence will be presented and linked with future considerations for intervention and research. During this interlude of development and refinement, best practice will rely on sound clinical reasoning skills that incorporate basic science to achieve a successful outcome when treating these challenging patients.
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Affiliation(s)
- Mark T Walsh
- Hand & Orthopedic Physical Therapy Associates, P.C., Levittown, Pennsylvania 19056, USA.
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237
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Sagadai S, Panchagnula U, Sundararajan R, Quraishi T. Residual neurological deficit after central neuraxial blocks. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2012. [DOI: 10.1016/j.tacc.2012.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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238
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Prior Lumbar Discectomy Surgery Does Not Alter the Efficacy of Neuraxial Labor Analgesia. Anesth Analg 2012; 115:348-53. [DOI: 10.1213/ane.0b013e3182575e1b] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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239
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Al-Nasser B. Early involvement of spinal cord in diabetic peripheral neuropathy may influence patient outcome after neuraxial anesthesia. J Anesth 2012; 26:951-2. [PMID: 22810502 DOI: 10.1007/s00540-012-1453-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 07/04/2012] [Indexed: 11/30/2022]
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240
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Forecast for perineural analgesia procedures for ambulatory surgery of the knee, foot, and ankle: applying patient-centered paradigm shifts. Int Anesthesiol Clin 2012; 50:126-42. [PMID: 22227428 DOI: 10.1097/aia.0b013e31821a00d0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although much of the current clinical research is directed toward practitioner-centered refinement of RA techniques and technology, it is important to consider pharmacologic advances in perineural analgesia as the next major patient-centered advancement of our specialty. With all due respect to excellent bench science work with novel drugs and toxins that may not gain approval of the Food and Drug Administration for many years, it is useful to know that four Food and Drug Administration-approved drugs are commercially available for potentially ground-breaking off-label use, pending ongoing research. The extent to which estimated clinical concentrations of clonidine, buprenorphine, and dexamethasone, seem to not influence A-fiber conduction holds significant progress for lower extremity perineural analgesia when weight bearing may be desired, if not at least reducing the risk of falls after these surgeries using typical local anesthetic nerve blocks. Research is also needed to determine the extent to which these four drugs may reduce the needed local anesthetic concentration to achieve a surgical nerve block (on bolus injection). Ongoing research in this direction seems to represent the next major advancement in the subspecialty, being distinguished from refinement research involving strictly techniques and technology.
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241
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Roberts L. Clinical conundrums in a case of upper quadrant dysfunction. MANUAL THERAPY 2012; 17:192-195. [PMID: 21680226 DOI: 10.1016/j.math.2011.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Revised: 05/16/2011] [Accepted: 05/17/2011] [Indexed: 05/30/2023]
Abstract
This case study charts the progress of a 60-year-old angling coach presenting with a complex upper quadrant dysfunction. Following a brief summary of the history and physical examination, the main focus of the paper explores the mechanical and physiological rationale for adopting a neurodynamic approach for a proposed double crush condition. This case further highlights mismatches that arose between the clinical findings and traditional healing timescales, and the importance of considering pathomechanics of the whole quadrant in complex clinical circumstances.
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Affiliation(s)
- Lisa Roberts
- Therapy Services Department, Southampton University Hospitals (NHS) Trust, Tremona Road, Southampton, Hampshire SO16 6YD, United Kingdom.
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242
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Clinical characteristics and surgical outcome of the symptomatic ossification of ligamentum flavum at the thoracic level with combined lumbar spinal stenosis. Arch Orthop Trauma Surg 2012; 132:465-70. [PMID: 22139388 DOI: 10.1007/s00402-011-1438-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To identify the clinical significance of coexistence of lumbar spinal stenosis (LSS) with thoracic ossification of ligamentum flavum (OLF), and to study the surgical outcome of the thoracic OLF patients with or without LSS. SUMMARY OF BACKGROUND DATA The OLF at the thoracic level (thoracic OLF) is a rare disease that causes acquired thoracic spinal canal stenosis. Thoracic OLF is frequently combined with other spinal disorders, such as LSS, and it is not uncommon for thoracic OLF to be misdiagnosed as LSS, resulting in delayed diagnosis. However, clinical impacts of the coexistence of LSS with thoracic OLF remain unknown. METHODS In the present study, 36 patients who underwent posterior decompression for OLF-induced thoracic myelopathy were retrospectively reviewed, and the adverse influence of the copresence of LSS with thoracic OLF was studied with regard to clinical features such as clinical symptoms and surgical outcome. RESULTS Out of 36 patients, 18 patients had LSS (combined group: C-group), and the remaining 18 patients had thoracic OLF only (thoracic group: T-group). No significant inter-group differences were found in terms of gender, age, follow-up period, and preoperative duration of symptoms. Regarding the etiology of LSS in the C-group, 12 cases had degenerative LSS, two cases had lumbar OLF, one case had degenerative LSS with lumbar OLF, one case had had degenerative LSS with lumbar OPLL, and two cases had traumatic LSS due to lumbar kyphosis after vertebral fracture. Clinical examination revealed that the T-group was significantly more likely to demonstrate Achilles hyper-reflexia, while the C-group was significantly more likely to demonstrate Achilles hypo-reflexia. The mean preoperative and postoperative JOA scores were not statistically different between the two groups. However, the mean recovery rate of the JOA score was 17.3% in the C-group, and 30.4% in the T-group. Statistical analysis revealed that the recovery rate of the C-group was significantly lower than that of the T-group. CONCLUSION Thoracic OLF with LSS will show a more severe clinical manifestation than that without LSS. In this study, we clearly indicated that the coexisting LSS in thoracic OLF will have adverse effects on the surgical results in thoracic OLF.
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Proximal Stimulus Confirms Carpal Tunnel Syndrome—A New Test? —A Clinical and Electrophysiologic, Multiple-Blind, Controlled Study. J Clin Neurophysiol 2012; 29:89-95. [DOI: 10.1097/wnp.0b013e318246b87d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Walcott BP, Coumans JVCE, Kahle KT. Diagnostic pitfalls in spine surgery: masqueraders of surgical spine disease. Neurosurg Focus 2011; 31:E1. [DOI: 10.3171/2011.7.focus11114] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Disorders of the spine are common in clinical medicine, and spine surgery is being performed with increasing frequency in the US. Although many patients with an established diagnosis of a true surgically treatable lesion are referred to a neurosurgeon, the evaluation of patients with spinal disorders can be complex and fraught with diagnostic pitfalls. While “common conditions are common,” astute clinical acumen and vigilance are necessary to identify lesions that masquerade as surgically treatable spine disease that can lead to erroneous diagnosis and treatment. In this review, the authors discuss musculoskeletal, peripheral nerve, metabolic, infectious, inflammatory, and vascular conditions that mimic the syndromes produced by surgical lesions. It is possible that nonsurgical and surgical conditions coexist at times, complicating treatment plans and natural histories. Awareness of these diagnoses can help reduce diagnostic error, thereby avoiding the morbidity and expense associated with an unnecessary operation.
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248
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Abstract
The management of acute pain remains challenging, with many patients suffering inadequate pain control following surgery. Certain populations are at unique risk for unrelieved pain. Evidence-based approaches taking into account patients' specific needs and problems will likely substantially improve their perioperative experience. These patients must be identified in the preoperative process, and an anesthetic/analgesic plan discussed and formulated. A targeted multimodal approach to pain management should be considered the best clinical practice. The most challenging patients may benefit most from the surveillance of an acute pain service that is able to monitor and coordinate care into the postoperative period.
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Affiliation(s)
- Kishor Gandhi
- Department of Anesthesiology, Jefferson Medical College, Thomas Jefferson University, 111 South 11th Street, Suite 8490, Philadelphia, PA 19107, USA.
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249
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Laulan J, Fouquet B, Rodaix C, Jauffret P, Roquelaure Y, Descatha A. Thoracic outlet syndrome: definition, aetiological factors, diagnosis, management and occupational impact. JOURNAL OF OCCUPATIONAL REHABILITATION 2011; 21:366-73. [PMID: 21193950 PMCID: PMC3526474 DOI: 10.1007/s10926-010-9278-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Thoracic outlet syndrome is a controversial cause of neck and shoulder pain due to complex mechanisms involving muscular dysfunction and nerve compression. Although management of thoracic outlet syndrome must be based on a multidisciplinary approach, physicians and occupational therapist should be familiar with the principles of diagnosis and treatment. METHOD, RESULTS AND CONCLUSION The purpose of this article is to review the definitions, diagnosis and management of this syndrome. A particular emphasis was described on the links between the workplace and the individual in the pathogenesis, prevalence in the workforce and the course of this disease.
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Affiliation(s)
- Jacky Laulan
- Service de chirurgie orthopédique
CHRU ToursHôpital TrousseauUnité de chirurgie de la main, Tours,FR
| | - Bernard Fouquet
- Service de médecine physique et de réadaptation
CHRU ToursHôpital TrousseauTours,FR
| | - Camille Rodaix
- UVSQ-APHP, Unité de pathologie professionnelle
Assistance publique - Hôpitaux de Paris (AP-HP)Hôpital Raymond PoincaréGarches,FR
| | - Penelope Jauffret
- UVSQ-APHP, Unité de pathologie professionnelle
Assistance publique - Hôpitaux de Paris (AP-HP)Hôpital Raymond PoincaréGarches,FR
| | - Yves Roquelaure
- LEEST, Laboratoire d'Ergonomie et d'Epidémiologie en Santé au Travail
Université d'Angers : EA4336CHU AngersINVSAngers,FR
| | - Alexis Descatha
- UVSQ-APHP, Unité de pathologie professionnelle
Assistance publique - Hôpitaux de Paris (AP-HP)Hôpital Raymond PoincaréGarches,FR
- CESP, Centre de recherche en épidémiologie et santé des populations
INSERM : U1018Université Paris XI - Paris SudHôpital Paul BrousseAssistance publique - Hôpitaux de Paris (AP-HP)16 avenue Paul Vaillant Couturier 94807 Villejuif Cedex, France,FR
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Warrender WJ, Oppenheimer S, Abboud JA. Nerve monitoring during proximal humeral fracture fixation: what have we learned? Clin Orthop Relat Res 2011; 469:2631-7. [PMID: 21213085 PMCID: PMC3148357 DOI: 10.1007/s11999-010-1760-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Accepted: 12/22/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND The incidence of neurologic injury after proximal humerus fractures is variable, ranging from 6.2% to as much as 67%. However, it is unclear what factors might contribute to these injuries or whether they can be prevented by intraoperative nerve monitoring. QUESTIONS/PURPOSES Therefore, using intraoperative nerve monitoring, we assessed the incidence, pattern of nerve involvement, and predisposing factors for nerve injury before and during shoulder fracture fixation. PATIENTS AND METHODS We used continuous intraoperative monitoring of the brachial plexus in 37 patients undergoing open operative treatment of proximal humerus fractures. Impending intraoperative compromise of nerve function was signaled by sustained neurotonic EMG activity or greater than 50% amplitude attenuation of transcranial electrical motor evoked potentials (MEPs) (or both). When a nerve alert occurred, current surgical activity and arm and retractor position were recorded and adjustments were made to relieve tension. RESULTS The intraoperative affected nerves included axillary (46%), combined (mixed plexopathy) (23%), radial (23%), musculocutaneous (4%), and ulnar (4%). Postoperatively, three patients had transient nerve palsies, which fully resolved within 3 weeks of surgery. Low body mass index (BMI) (22.7 ± 2.8), history of cervical spine disease, diabetes mellitus, and delay in surgical treatment (14 ± 2.9 days from time of injury) were associated with an increased incidence of nerve dysfunction. CONCLUSIONS Our observations suggest transcranial electrical MEPs are sensitive indicators of impending iatrogenic injury to the brachial plexus or peripheral nerves (or both) during open operative treatment of proximal humerus fractures. The use of intraoperative nerve monitoring during these procedures may be considered for the prevention of nerve injury, particularly in patients with underlying cervical spine disease, low BMI, diabetes mellitus, and/or delay in surgical treatment greater than approximately 14 days. LEVEL OF EVIDENCE Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- William J. Warrender
- Department of Orthopaedic Surgery, University of Pennsylvania Health System, 3B Orthopaedics, Pennsylvania Hospital, 800 Spruce Street, 8th Floor Preston, Philadelphia, PA 19107 USA
| | | | - Joseph A. Abboud
- Department of Orthopaedic Surgery, University of Pennsylvania Health System, 3B Orthopaedics, Pennsylvania Hospital, 800 Spruce Street, 8th Floor Preston, Philadelphia, PA 19107 USA
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